Myasthenia Gravis is a chronic neuromuscular/autoimmune disorder; its hallmarks are increased and varying degrees of weakness in the voluntary muscles in the body. Myasthenia Gravis is often characterized by weakness in the muscles that control eye movements, eyelids, arm and leg movements, breathing, coughing, facial expressions, swallowing, and chewing. It often presents as eyelid drooping (ptosis), double vision, difficulties in breathing, speaking, or eating, and generalized fatigue, even with minimally exertive activities. While there is no cure for this disease, treatments are available which can increase quality of life and decrease symptom significance.
Myasthenia Gravis is caused by a communication breakdown between the nervous system and muscles due to damage from the autoimmune nature of the disease; muscle contractions are prevented from successful occurrence by this disease, leading to complications and annoyance on part of the affected person. In Myasthenia Gravis, the thymus gland does not decrease in size as it does in a person without the disease; sometimes, thymomas (tumors of the thymus) can occur. While generally benign, caution must be taken as tumors have the capacity for malignancy. While Myasthenia Gravis can occur in any ethnicity or age group, it is most common in women under 40 and men over 60.
Often, the first symptom subjectively noted in Myasthenia Gravis is eye muscle weakness; any presentation of a unilateral or bilateral eyelid droop is cause for evaluation by your eye care provider. Further, this disease may cause double vision or blurred vision; as with abnormal presentation of eyelid droop, any double vision or sudden presentation of blurred vision warrants a visit to your eye doctor!
The diagnostic testing for Myasthenia Gravis can be varied, but often includes a medical history review, testing of eye movement capabilities, an ice test in patients with ptosis (testing is done to ascertain if ptosis reduces with ice), bloodwork, and a chest CT or MRI to monitor for thymoma presence. Treatment for this disease can be a compilation of approaches, from medication to surgical removal of the thymus gland to dietary and activity changes. Patients with Myasthenia Gravis may especially benefit from solid sleep every night, an increase in daily levels of Vitamin D, Calcium, and fiber, and an increase in aerobic exercise (within fatigue limitations).
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As a busy ophthalmic practice, we will often hear many of the same complaints or questions from different patients. One of the most common we hear is about cataracts. Cataracts, a topic we will discuss in depth later this year in our blog, are a clouding of the natural intraocular lens. Cataract surgery removes this clouded lens, replacing it, instead, with a clear, plastic, artificial lens. Patients will often question if the cataract grew back because they have a family member or friend who said it happened to them; a condition known as posterior capsular opacity, or an “after-cataract,” can and often does develop months or even years after successful cataract surgery. This opacity affects the capsule in which the natural lens once sat, and in which the artificial lens is placed. Symptoms can include blurred vision, glare, halos, and poor night vision. If treatment is advised, it is in the form of a simple, in-office laser procedure.
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Pingueculae and pterygia are growths which can affect vision and the comfort of the eyes. They are often indicators of a patient who enjoys outdoor activities as UV light, wind, and dust exposure can instigate the development of either condition. While neither of these conditions are usually indicative of malignancy, any growth on the surface of the eye should be investigated properly by a medical eye care professional.
A pinguecula is a yellowish patch or bump on the conjunctiva (the “white” of the eye) near the cornea (the clear cap of the eye). Most often pingueculae will appear on the side of the eye closest to the nose (the nasal portion of the eye). They may appear similar to a callus on the skin of the eye. Pingueculae can progress into a pterygium.
A pterygium is an often triangle-shaped growth of fleshy tissue of the conjunctiva that eventually extends over the cornea. Pterygia may encroach on the center of the eye, obstructing vision significantly. Pterygia often develop from pingueculae. Pterygia may be significant enough to change astigmatic prescription, as well.
Both pingueculae and pterygia can be irritating to the ocular surface, causing itching, burning, foreign body sensations, and grittiness; vision may be distorted; finally, aesthetic dissatisfaction is a common result of both conditions.
Treatment for both pingueculae and pterygia include surgical removal, monitoring, and topical steroid drops. Surgical removal may be effective, but both conditions have a degree of recurrence likelihood.
While no factors can fully prevent pterygia or pingueculae development, wearing wraparound sunglasses when outdoors, wearing safety eyewear in dry, dusty conditions, and using artificial tears in dry conditions can aide in reducing risks for either condition.
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Nearly every medical professional decries the adverse effects of smoking to your overall health. Smoking can increase your risks for cancer, emphysema, chronic bronchitis, heart attacks, strokes, cognitive dysfunction, female infertility, and Parkinson’s disease. In addition, smoking can severely decrease or even destroy ocular function.
WHAT SMOKING DOES
Smoking decreases blood flow, can harden arteries, and can reduce antioxidant supply. These factors can instigate or worsen already developed ocular conditions. Smoking can topically irritate the eyes, leading to allergic conjunctivitis and/or dry eye, but can permanently damage the retina, macula, intraocular lens, and other portions of the eyes. If you are a smoker, routine eye exams are important to monitor potential ocular damage.
WHAT CAN SMOKING DO TO THE EYES?
Smoking can cause numerous complications to the eyes, but a list of the most common complications is below.Macular Degeneration (this condition can permanently destroy central vision)Early Cataract Development (while cataracts progress normally with age, smoking can expedite development)Dry Eye and Allergic Conjunctivitis (smoking can irritate the surface of the eye, causing inflammation)Uveitis (inflammation in the middle layer of the eye, leading potentially to eye pain, floaters, and loss of vision, among other complications)Graves’ Disease in patients with active thyroid disordersOptic Neuropathy (damage to the optic nerve, which can lead to irreparable blindness)Retinopathy of Prematurity in infants born to smoking mothers (this condition is an abnormal growth of blood vessels in the retina, leading to complicated vision)
HOW TO QUIT
There are many methods through which you can quit smoking, varying from medication to support groups to quitting “cold turkey.” Whichever method you choose, know that your decision to quit smoking can have very beneficial results for your eye health and your overall health. For assistance in quitting smoking, please visithttp://www.smokefree.gov/ . Good luck! We know you can do it!
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Cataracts are a very common eye condition which can reduce vision and quality of life with their progression. Responsible for up to 51% of the world’s blindness, cataracts often develop slowly over the course of years. Thankfully, in the United States we have lower rates of vision complications due to cataracts (when compared to more prevalently affected areas like Africa, Indonesia, the Middle East, India, and Burma) because of our medical advances and availability of care.
WHAT ARE CATARACTS?
Cataracts are a clouding of the natural intraocular lens of the eye; this clouding can lead to visual distortions and decreased quality of life, especially if left untreated. Cataracts reduce vision by lens opacification, meaning that the lens can become so dense that it limits the eye’s ability to pass light through to the retina, where the majority of our vision occurs. The term cataract is derived from the latin cataracta, meaning waterfall; comparing the cloudiness of a cataract-affected lens to the frothy white waters produced by Niagara Falls is an apt comparison.
WHAT CAUSES CATARACTS?
Age-related cataracts are a natural progression, but certain lifestyle factors can expedite the rate of progression and increase the significance of cataract severity. Smoking, steroid use, and exposure to UV-B light can increase how quickly cataracts are developed. Cataracts can also be related to trauma or can be congenital. Age-related cataracts often begin much earlier than we would like to think; approximately 42% of people in the US between the ages of 52-64 have some semblance of cataract. This percentage increases with age; 91% of US adults between the ages of 75-85 will have developed cataracts.
WHAT ARE SYMPTOMS OF CATARACTS?
The most common symptoms of cataracts include blurred vision, distorted vision, decreased color perception, glare, halos around lights, and decreased visual acuity in poor lighting conditions. Because age-related cataracts develop over many years, patients may not notice the severity of their condition because their vision has been slowly decreasing over time. This is one reason why it is integral to have routine eye examinations with your eye care provider. Cataracts, especially advanced cataracts, can increase your risk for injuries at home, while driving, and at work; when your vision is decreased, your ability to react quickly and appropriately for certain situations may also be decreased.
HOW ARE CATARACTS TREATED?
Depending on your degree of cataract severity, your eye care specialist may recommend monitoring your eyes for progression or cataract surgery. Surgery in the United States is most commonly done through a procedure called phacoemulsification; this procedure uses ultrasonic waves to break up the cloudy lens before it is removed through a small incision in the eye. The cloudy lens is replaced with a clear, plastic lens which can often provide significant vision improvements, even without glasses! There are many types of lenses used for cataract surgery, but the most common lens is a monofocal intraocular lens, which corrects for one range of vision, usually distance vision. Post-operatively, patients will need to use eye drops, an eye shield for sleeping for a period of time, and will need to limit their exertive activities and avoid exposure to dusty, dirty environments.
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